Health Matters: Occupational therapy can help cancer-related cognitive problems

By Chrysanne Karnick

Cancer and its treatment can cause varying side effects for patients, compromising their
function and day-to-day life.

In addition to physical side effects, many patients experience cognitive impairment, often
described as an overall feeling of mental fogginess.

In fact, more than 70% of people with cancer experience cognitive problems, according
to the American Society of Clinical Oncology (ASCO).

Fortunately, research has shown that occupational therapy during and after cancer treatment can help address cognitive problems and speed functional recovery.

The occupational therapy program at Princeton Rehabilitation at Penn Medicine Princeton
Medical Center offers outpatient treatment for patients of all ages who are experiencing
cancer-related cognitive impairment.

What is cancer-related cognitive impairment?

Cancer treatments, surgery and the disease process itself can cause functional and structural changes of the brain, resulting in cognitive impairments or problems thinking, paying attention and remembering things.

These problems may range in severity. For example, challenges can vary from not being able to open a pill bottle to not being able to recall why you are taking the medication.

However, as the ASCO notes, even mild problems can make daily activities difficult and can interfere with work, school, and time with family members and friends.

People often associate chemotherapy with cognitive impairment, but according to the
American Cancer Society, several factors can increase the risk of developing cancer-related
cognitive impairment, including:

• The cancer itself; for example, brain tumors.
• Other drugs used as part of treatment, such as steroids, anti-nausea, or pain medicines.
• Other conditions or illnesses, such as diabetes or high blood pressure.
• Symptoms such as tiredness, pain, or sleep problems.
• Emotional distress, such as depression or anxiety.
• Older age.
• Being weak or frail.
• Surgery and the drugs used during surgery (anesthesia).
• Infection.
• Hormone changes or hormone treatments.
• Being postmenopausal.
• Nutritional deficiencies.
• Use of alcohol or other substances that can change your mental state.

Additionally, the general stress of a cancer diagnosis can contribute to cognitive impairment.

What are the common signs of cancer-related cognitive impairment? According to the ASCO, common signs of cancer-related cognitive impairment include:

• Trouble concentrating, focusing or paying attention.
• Difficulty remembering things, such as names, dates, or phone numbers.
• Feeling disoriented, like you are in a mental fog.
• Feeling very confused, taking longer to process new information, or having difficulty
understanding things.
• Difficulty making decisions or thinking things through.
• Difficulty organizing your thoughts or doing mental tasks, such as finding the right word
or balancing your checkbook.

If you or a loved one experiences these symptoms, talk with your doctor. In some instances, the symptoms may last a short time and resolve on their own after cancer treatment ends. In others, occupational therapy may be recommended to help manage challenges.

How does occupational therapy help? Occupational therapy teaches patients strategies they can use in their daily life to overcome cognitive challenges.

At Princeton Rehabilitation, the treatment approach is individualized based on the patient’s
needs. The patient is evaluated to determine the level of impairment, the cause, and
appropriate treatment options.

The initial evaluation includes a detailed discussion of what the patient is struggling with in
their daily life, such as work duties, childcare, leisure tasks and household tasks.

The occupational therapist breaks down the task to find the exact area of deficit and then
teaches the patient how to improve the skill or new ways to accomplish the task.

Occupational therapy for cancer-related cognitive impairment typically lasts a few weeks to a few months.

Can cancer-related cognitive impairment be prevented? Right now, there is no known way to prevent cancer-related cognitive impairment.

However, patients can do certain things at home to help manage their symptoms. ASCO offers these tips:

• Do one thing at a time. Avoid stopping to do something else.
• Use word play, such as making up a rhyme, to help you remember things.
• Get plenty of rest.
• Exercise. Physical activity helps your brain stay alert. Try walking, swimming, or
gardening. Yoga or meditation can also help you relax and clear your mind.
• Do things that exercise your brain. These can include doing puzzles, word games,
painting, playing an instrument, or learning a new hobby.
• Carry around a small pad and a pen or pencil to write down notes and reminders. Or
download a note-making app on your smartphone or tablet.
• Use a calendar or a daily organizer to keep track of upcoming appointments, activities,
and important dates.
• Place sticky notes around the house and at work to remind you of important tasks. You
can also set reminders using your phone or email calendar.
• Color code or label certain cabinets or drawers where you store things at home.
• Put items, such as car keys, back in the same place every time. This will help you find
them easily.

And don’t be afraid to ask for help. While cognitive impairment is a common side effect of
cancer and cancer treatment, it can be managed to improve function and restore quality of life.

To find a physician with Penn Medicine Princeton Health, call 888-742-7496 or visit

Chrysanne Karnick, MSOT, OTR/L, CLT, is an occupational therapist and certified lymphedema therapist with Princeton Rehabilitation.